种植体周围炎治疗方法的研究进展_王懿

Anti-infective treatment of peri-implant mucositis:a randomised controlled clinical trialLisa J.A.Heitz-Mayfield Giovanni E.Salvi Daniele Botticelli Andrea Mombelli Malcolm Faddy Niklaus ngOn Behalf of the ImplantComplication Research Group (ICRG)Authors’affiliations:Lisa J.A.Heitz-Mayfield ,Centre for Rural and Remote Oral Health,The University of Western Australia,Crawley,WA,AustraliaGiovanni E.Salvi ,School of Dental Medicine,University of Bern,Bern,SwitzerlandDaniele Botticelli ,Ariminum Odontologica s.r.l.,Rimini,ItalyAndrea Mombelli ,Department of Periodontology,University of Geneva,Geneva,SwitzerlandMalcolm Faddy ,Queensland University of Technology,Brisbane,Qld,AustraliaNiklaus ng ,Faculty of Dentistry,The University of Hong Kong,Hong Kong SAR,China Corresponding author:Prof.Lisa J.A.Heitz-MayfieldCentre for Rural and Remote Oral Health The University of Western Australia Crawley WAAustraliaTel.:þ61893217581Fax:þ61893212741e-mail:heitz.mayfield@.auKey words:anti-infective treatment,chlorhexidine,non-surgical debridement,oral hygiene,peri-implant mucositis,RCT AbstractAim:To compare the effectiveness of two anti-infective protocols for the treatment of peri-implant mucositis.Materials and methods:Twenty-nine patients with one implant diagnosed with peri-implant mucositis (bleeding on probing [BOP]with no loss of supporting bone)were randomly assigned to a control or test group.Following an assessment of baseline parameters (probing depth,BOP ,suppuration,presence of plaque),all patients received non-surgical mechanical debridement at the implant sites and were instructed to brush around the implant twice daily using a gel provided for a period of 4weeks.The test group (15patients)received a chlorhexidine gel (0.5%),and the control group (14patients)received a placebo gel.The study was performed double blind.After 4weeks,patients were instructed to discontinue using the gel and to continue with routine oral hygiene at the implant sites.Baseline parameters were repeated at 1and 3months.Results:At 1month,there was a statistically significant reduction in the mean number of sites with BOP and mean probing depth measurements at implants in both groups.There were also some statistically significant changes in these parameters from 1to 3months.However,there were no statistically significant differences between test and control groups.One month following treatment,76%of implants had a reduction in BOP .Complete resolution of BOP at 3months was achieved in 38%of the treated implants.The presence of a submucosal restoration margin resulted in significantly lower reductions in probing depth following treatment.Conclusions:Non-surgical debridement and oral hygiene were effective in reducing peri-implant mucositis,but did not always result in complete resolution of inflammation.Adjunctive chlorhexidine gel application did not enhance the results compared with mechanical cleansing alone.Implants with supramucosal restoration margins showed greater therapeutic improvement compared with those with submucosal restoration margins.Biological complications affecting the supporting tissues at dental implants include peri-implant mucositis and peri-implantitis.Peri-implant mu-cositis is defined as inflammation of the peri-implant soft tissues without loss of supporting bone and has been reported to occur in up to 80%of patients with implants (Zitzmann &Berglundh 2008),most frequently in smokers (S.Rinke,S.Ohl,D.Ziebolz,nge,P.Eickholz,unpub-lished data).A clinical diagnosis of peri-implant mucositis is made when there is bleeding following probing of the peri-implant sulcus,in the absence of radiographic bone loss.In contrast,when there is bone loss around an implant in addition to bleeding on probing (BOP),the diagnosis is peri-implantitis (Zitzmann &Berglundh 2008).The peri-implant soft tissues are similar in composition to their gingival counterparts around teeth and respond in a similar way to biofilm formation,with an inflammatory cell infiltrate (Berglundh et al.1991).Experimental studies in humans have demonstrated that a 3-week period of plaque accumulation has a similar cause-and-effect relationship at teeth (gingivitis)andimplantsImplant Complication Research Group (ICRG):Andrea Mombelli ,Geneva,Switzerland;Daniele Botticelli ,Rimini,Italy;Malcolm Faddy ,Brisbane,Australia;Fritz Heitz ,Perth,Australia;Giovanni E.Salvi ,Bern,Switzerland;Gregory Seymour ,Dunedin,New Zealand;Lisa J.A.Heitz-Mayfield ,Perth,WA,Australia;Mary Cullinan ,Dunedin,New Zealand;Niklaus ng ,Hong Kong;Peter Clarke-Ryan ,Brisbane,Australia;Pierre-Jean Loup ,Geneva,Switzerland.Date:Accepted 18August 2010To cite this article:Heitz-Mayfield LJA,Salvi GE,Botticelli D,Mombelli A,Faddy M,Lang NP,On Behalf of the Implant Complication Research Group (ICRG).Anti-infective treatment of peri-implant mucositis:a randomised controlled clinical trial.Clin.Oral Impl.Res .22,2011;237–241.doi:10.1111/j.1600-0501.2010.02078.xc 2011John Wiley &Sons A/S237(peri-implant mucositis)(Pontoriero et al.1994; Zitzmann et al.2001).Therefore,peri-implant mucositis appears to represent the host response to the bacterial challenge as the counterpart to gingivitis at tooth sites(Heitz-Mayfield&Lang2010).It is assumed that peri-implant mucositis is the pre-cursor for peri-implantitis,as gingivitis is the precursor for periodontitis(ng,D.D. Bosshardt,M.Lulic,unpublished data). Protocols similar to those used to treat gingi-vitis have been adopted to treat peri-implant mucositis.However,few studies are available evaluating anti-infective protocols for the treat-ment of peri-implant mucositis(Heitz-Mayfield &Lang2004;Renvert et al.2008;Maximo et al. 2009;Ramberg et al.2009;Tho¨ne-Mu¨hling et al. 2010).As peri-implant mucositis may progress to peri-implantitis,an effective treatment resulting in resolution of inflammation would be the pre-requisite for the prevention of peri-implantitis. Thus,the aim of this study was to evaluate the effectiveness of two anti-infective protocols for the treatment of peri-implant mucositis.Material and methodsPatient selectionPatients were recruited from four clinical and university centres(W est Perth Periodontics,Wes-tern Australia,Australia;University of Bern, Switzerland;University of Geneva,Switzerland; Arminum Odontologica,Rimini,Italy).In total, 29patients with one implant diagnosed with peri-implant mucositis(bleeding on light probing [0.2–0.3N],with no loss of supporting bone) were included in the study.An investigator meeting was held before the commencement of the study to standardise the examination and treatment protocols and to cali-brate for the parameters assessed.Power calculationThe sample size of(at least)14patients in each group resulted in a power of80%to detect a mean difference of 1.1mm in probing depths between groups.Exclusion criteriaPatients who smoked420cigarettes/day(self-reported)were excluded as well as patients with uncontrolled diabetes.A full-mouth plaque score (FMPS)was obtained at baseline and patients with inadequate oral hygiene(FMPS425%)or untreated periodontitis were excluded.Baseline measurementsBaseline clinical measurements including probing depths,presence or absence of plaque,BOP and/or suppuration,were obtained at four sites(mesial,distal,facial and oral)per implant.Probing depthmeasurements were made using a graduated perio-dontal probe with a light probing force(approxi-mately0.2–0.3N)(Gerber et al.2009).Radiographswere taken to confirm that there was no loss ofsupporting bone.Restorative margins were classi-fied as supramucosal or submucosal.Submucosal plaque samples,at the deepestimplant site,were obtained using a single paperpoint,which was transferred to a sterile Eppen-dorf s tube containing TE buffer.One-hundredmicrolitres of sodium hydroxide was added toeach sample tube and the samples were sent tothe Oral Microbiology Laboratory at the Univer-sity of Bern,Bern,Switzerland,where they wereanalysed using the checkerboard DNA–DNAhybridization technique(Socransky et al.1994).The presence and levels of the40subgingivalspecies(Socransky et al.1998)with the additionof Staphylococcus aureus were evaluated.Treatment protocolFollowing baseline measurements,the implantsdiagnosed with peri-implant mucositis were me-chanically debrided using titanium-coatedGracey curettes(HuFriedy s,Chicago,IL,USA)or carbonfibre curettes(KerrHawe s SA,Bioggio,TI,Switzerland)followed by prophylaxis with arubber cup and polishing paste.Patients wereinstructed to brush around the implant twicedaily using1cm of the gel provided for a periodof4weeks.Test groupPatients in the test group received a plastic bottlecontaining100ml of0.5%chlorhexidinegel(Plak-Out s Gel,KerrHawe s SA,Bioggio,TI,Switzerland).Control groupPatients in the control group received an identicalplastic bottle containing placebo gel(withoutchlorhexidine).The placebo gel was prepared tothe same consistency,appearance and taste as theactive chlorhexidine gel.Placebo and chlorhexidinegels were prepared in a pharmaceutical laboratory(Compounding on Oxford,Leederville,WA,Aus-tralia)and distributed to the participating centres.RandomisationRandomisation was performed for each centreseparately using randomisation tables with per-muted blocks of four.Allocation concealmentExaminers and patients were unaware of the alloca-tion to test and control for the duration of the study.1-and3-month re-evaluationClinical parameters(probing depth measure-ments,presence or absence BOP and/or suppura-tion and plaque)were recorded and plaquesamples were taken at1and3months followingtreatment.Any adverse events were recorded.Ethics approvalAll participating centres obtained ethics approvalfrom the appropriate ethics committee in theirregion before the commencement of the study.Patients were provided with written informationregarding the aims of the study and providedinformed consent.Statistical analysisThe outcome variables of interest following treat-ment in either the test or control group were(i)number of sites with BOP at the treated implant,(ii)sum of probing depths at the treated implant(foursites measured)and(iii)the total DNA count at thedeepest implant site.These variables were mea-sured at baseline,1and3months after treatment.The following possible confounding covariateswere also recorded:1.Smoking history(non-smoker,former smo-ker,current smoker[o20cigarettes/day]);2.History of treated periodontitis(yes or no);3.FMPS at baseline(o12%or!12%);4.FMBS at baseline(o12%or!12%);5.Submucosal restoration margin at baseline(yes or no);6.Number of sites with plaque at the treatedimplant at baseline(for1-month treatmentoutcome)and at1month(for3-month treat-ment outcome).The following possible microbial confoundingcovariates were measured at the deepest implantsite at baseline(for1-month treatment outcomes)and at1month(for3-month treatment outcomes):1.Proportions of the total DNA count of redcomplex species(Socransky et al.1998)(0:4%,1:44–10%,2:410%);2.Proportions of the total DNA count of orangecomplex species(Socransky et al.1998)(0:o10%,1:10–30%,2:430%);3.Level of Staphylococcus aureus(0:o104,1:104–105,2:105–106,3:!106);4.Level of Aggregatibacter actinomycetem-comitans(0:o104,1:104–105,2:105–106,3:!106).In addition to simple pair-wise comparisons,multiple regression analysis was used to quantifythe treatment outcomes,with the mean outcomebeing a function of the above covariates,includingtest and control groups,and the outcome of theearlier examination.Only statistically significantcovariates were retained,using a backward elim-Heitz-Mayfield Lisa et alÁTreatment of peri-implant mucositis238|Clin.Oral Impl.Res.22,2011/237–241c 2011John Wiley&Sons A/Sination process;this enabled contributions from all of these covariates to the outcomes to be assessed. As two responses,difference between baseline and 1month and difference between1and3months were considered for each outcome,a Bonferroni adjustment of doubling all P-values was made,so that a significance level of0.025was the require-ment for individual covariate retention.ResultsTwenty-nine patients with one implant diag-nosed as peri-implant mucositis participated in the study,15in the test and14in the controlgroup.There were17non-smokers,eight former smokers and four smokers(o20cigarettes/day). All patients were re-examined at1and3months. No adverse events were reported at any observa-tion time.Baseline demographics including age, gender,number of smokers,former smokers and non-smokers,history of treated periodontitis and presence of a submucosal restoration margin for test and control group are presented in T able1.BOPData on numbers of sites with BOP at the treated implants(total four sites evaluated)at baseline,1 and3months are summarised in T able2. Simple pair-wise comparisons showed that there were significant reductions in the number of sites with BOP from baseline to1month for both test and control groups(P-values o0.05), with little apparent change between1and3 months(P-values40.1).There was no statisti-cally significant difference in the changes in BOP between the test and control groups at1month or at3months(P-values40.1).The multiple regression analysis showed that, not surprisingly,greater reductions in BOP oc-curred at implants with higher BOP scores initi-ally(P-values o0.01),and this corresponded to significant reductions in BOP between baseline and1month,and between1and3months. None of the other covariates had any significant effect on the changes in BOP(P-values40.05).The following estimates of BOP were obtainedfrom the multiple regression analysis:Mean number of sites BOP at1month¼0:74þ0:15Ânumber of sitesBOP at baselineandMean number of sites BOP at3months¼0:31þ0:57Ânumber of sitesBOP at1monthIn other words,there were up to67%reduc-tions in mean BOP from baseline to1month andfurther reductions of up to33%from1to3months.Higher plaque scores did tend to reducethese improvements,but such effects did notreach statistical significance(P-values40.05).The number of patients with a reduction,nochange or increase in the number of BOP positivesites at the treated implants at1and3months isdescribed in Fig.1.T able3shows the number ofpatients with sites BOP at baseline,1and3months.At3months,11patients(38%)hadcomplete resolution of inflammation(absence ofBOP at all four sites).Probing depth changesData on probing depths in millimetres(four sitesmeasured)at baseline,1and3months are sum-marised in T able4.Simple pair-wise comparisons showed thatthere were significant reductions in mean prob-ing depth from baseline to1month(40.5mm)for both test and control groups(P-values o0.01),with little apparent change between1and3months(P-values40.1).There were no statisti-cally significant differences in mean probingdepth reductions between the test and controlgroups at1or3months(P-values40.1).The multiple regression analysis showed that asubmucosal restorative margin at baseline had asignificant negative effect on the probing depthreduction at1month(P-value o0.01),butno significant effect between1and3months(P-value40.1).The following estimated probing depth reduc-tions were obtained from the multiple regressionanalysis:Mean change in sum of probing depthsfrom baseline to1month¼À4:1if restorationmargin at baseline was supramucosal;orÀ1:8if restoration margin at baselinewas submucosalAn unexpectedfinding was a significant effect ofthe proportion of orange complex species,wherebyindividuals with higher levels of these species at1month experienced further reductions in meanprobing depth at3months,while those with lowerlevels experienced some increase(P-value o0.05).Table1.Baseline patient demographics for con-trol and test groupTest group (N¼14)Control group (N¼15)Mean age(years)5753 Female69 Current smokers22 Former smokers62 Non-smokers710 History of treatedperiodontitis99Submucosal restoration margin 912Table2.Mean number of BOP-positive sites at treated implantsBOP Test Control Significance of differencebetween test and controlmeans(P)Mean SD Mean SDBaseline 2.5 1.0 2.3 1.040.101month 1.2w0.9 1.0w 1.040.103months 1.10.90.70.940.10w Statistically significant reduction from baseline to1month.SD,standard deviation;BOP,bleeding onprobing.Baseline - 1 Month 1 Month - 3 Months3 sitesFig.1.Number of patients with a reduction,no change or increase in the number of sites bleeding on probing from baseline to1month and1–3months following treatment.Heitz-Mayfield Lisa et alÁTreatment of peri-implant mucositisc 2011John Wiley&Sons A/S239|Clin.Oral Impl.Res.22,2011/237–241None of the other covariates had any significant effects on mean probing depth (P -values 40.1).The following estimated mean probing depth reductions were obtained from the multiple re-gression analysis:Mean change in sum of probing depths from 1to 3months ¼þ1:2if orange complexproportion at 1month 30%;or À0:9if orange complex proportion at 1month >30%Total DNA countData on total DNA counts at baseline,1and 3months are summarised in T able 5.Simple pair-wise comparisons showed that there were no significant differences in mean total DNA counts between test and control groups (P -values 40.1),a significant reduction in mean DNA counts between baseline and 1month (P -value o 0.05)and no significant difference between 1and 3months (P -value 40.1).However,the multiple regression analysis showed that there were sig-nificant (P -value o 0.01)changes in mean total DNA count between 1and 3months,which were dependent on the total DNA count at 1month.Estimated changes wereMean total DNA count at 1month ¼0:6Âtotal DNA count at baseline Mean total DNA count at 3months ¼7:4Â104if total count ¼1041:5Â105if total DNA count at 1month ¼1052:9Â105if total count at 1month ¼106In other words,there was some further reduc-tion in mean total DNA count between 1and 3months,but only if the total DNA count at 1month was sufficiently high (41.7Â105).The multiple regression analysis also showed that there was a tendency for patients who were smokers and/or had a history of periodontitis to have higher mean total DNA counts at 3months,but these effects did not reach statistical significance (P -values 40.05).DiscussionThis randomised placebo-controlled double-blind study found that mechanical debridement with and without the application of antiseptics re-sulted in a reduction in BOP and probing depthsthroughout the 3-month period of the study,with most of the improvement occurring in the first month.However,there was no added benefit in the adjunctive use of chlorhexidine gel indicating that mechanical debridement in conjunction with oral hygiene alone is effective in reducing peri-implant soft tissue inflammation.In a similar recent clinical study involving 13partially dentate patients with 36implants diag-nosed with peri-implant mucositis,no advantage of adjunctive chlorhexidine (0.12%),applied as a mouth rinse,compared with mechanical debride-ment alone was found (Tho ¨ne-Mu ¨hling et al.2010).These results confirm the findings of an experi-mental peri-implant mucositis study,in cynomol-gus monkeys,comparing mechanical debridement and mechanical debridement with chlorhexidine (0.12%)application.No statistically significant differences in clinical or histological signs of in-flammation between the two treatment groups were identified.Both mechanical therapy alone and combined with chlorhexidine irrigation re-sulted in minimal inflammation compatible with clinical health (Trejo et al.2006).Nevertheless,as there were no adverse effects reported in the present study,adjunctive chlor-hexidine gel may also be recommended.While there was a significant reduction in BOP in the present study,only 38%of the implants diagnosed with peri-implant mucositis had com-plete resolution of BOP at 3months.At 3months,38%of the implants had one BOP-positive site,17%had two BOP-positive sites and 7%had three BOP-positive sites.Other clinical studies evaluating treatment of peri-implant mucositis using adjunctive antisep-tic agents including essential oils (Ciancio et al.1995),chlorhexidine rinsing (Felo et al.1997),chlorhexidine rinsing plus chlorhexidine gel ap-plication (Porras et al.2002)and 0.3%triclosan dentrifice use (Ramberg et al.2009)or mechan-ical debridement alone (Maximo et al.2009)have reported similar reductions in BOP following treatment.None of the treatment protocols tested have reported complete resolution of in-flammation at all implant sites.In the present study,microbiological changes following treatment did not show any significant differences between test and control groups.Overall,there was some reduction in the total DNA count at 1month following treatment.Then,further reductions were only found if the count at 1month was sufficiently high.Increases occurred if the total count at 1month was low,suggesting the establishment of an equilibrium.Similarly,in another clinical study evaluating treatment of peri-implant mucositis,an initial reduction in bacterial load was followed with bacterial counts after 8months comparable with baseline (Tho ¨ne-Mu ¨hling et al.2010).Table 5.Mean total DNA count Æstandard deviation (SD)at baseline,1and 3months in control and test groupsLog (total DNA count)Test Control Significance of difference between test and control means (P )Mean SD Mean SD Baseline 5.240.5 5.440.3740.101month 5.07w 0.56 5.21w 0.5040.103months5.310.485.090.5340.10w Statistically significant reduction from baseline to 1month.Table 3.Number and percentage of patients with corresponding number of BOP-positive sites at baseline,1and 3monthsNumber of sites with BOP N (%)of patients (baseline)N (%)of patients (1month)N (%)of patients (3months)008(28%)11(38%)18(28%)12(41%)11(38%)25(17%)7(24%)5(17%)312(41%)2(7%)2(7%)44(14%)00BOP ,bleeding on probing.Table 4.The sum of probing depths (mm)Æstandard deviation (SD)at baseline,1and 3months in test and control groupSum of probing depths mm (mesial,distal,oral,facial)Test Control Significance of difference between test and control means (P )Mean SD Mean SD Baseline 14.7 3.714.4 3.840.101month 12.5w 4.011.7w 3.840.103months12.53.711.93.440.10w Statistically significant reduction from baseline to 1month.Heitz-Mayfield Lisa et al ÁTreatment of peri-implant mucositis240|Clin.Oral Impl.Res.22,2011/237–241c 2011John Wiley &Sons A/SWhen the proportion of the total DNA counts of orange complex species was430%at1month, there was an unexpected decrease in mean probing depth at3months,while if it was o30%there was an increase in the mean probing depth at3 months.One explanation of this observation may be that changes in proportions of specific bacterial species or complexes did not play as important a role as the reduction in total bacterial counts in peri-implant mucositis treatment.In this study,smoking did not have any sig-nificant effect on the treatment outcomes(P-values40.1).There were no statistically signifi-cant differences between non-smokers and for-mer smokers in reduction in BOP or probing depth reductions.The lack of significant effects of smoking could be explained by the small number(four)of smokers in the study and the exclusion of heavy smokers(420cigarettes/day) in the recruitment of the study population.An importantfinding in this study was the negative effect of a submucosal restorative mar-gin on the treatment outcome.Implants with submucosal restoration margins had statistically significantly less reduction in probing depth fol-lowing treatment than those with supramucosalmargins.Thisfinding is perhaps not surprisingconsidering the association between subgingivalrestoration margins at teeth and periodontal in-flammation and loss of attachment(Strub&Belser1978;Lang et al.1983;Felton et al.1991;Scha¨tzleet al.2001).A quantitative relationship betweenmarginal discrepancy and periodontal tissue in-flammation was reported for subgingivally locatedcrown margins(Felton et al.1991).Furthermore,an association between inadequate access for oralhygiene and peri-implantitis has been reportedrecently(Serino&Stro¨m2009).The negative influence of a submucosal re-storative margin shown in the present study mayhave implications for placement protocols ofimplants.Therefore,where possible,implantrestoration margins should be positioned at orabove the mucosal margin in order to facilitateaccess for biofilm control.In conclusion,this study showed thatnon-surgical debridement and oral hygienewith and without adjunctive chlorhexidine gelwere effective in the treatment of peri-implantmucositis.However,the study has also docu-mented that this successful anti-infective proto-col did not always result in complete resolutionof inflammation.Implants with supramucosalrestoration margins showed greater improve-ment following the treatment of peri-implantmucositis compared with those with submucosalrestoration margins.Acknowledgements:The authorsacknowledge the assistance of Regula Hirschi,Marianne Weibel and Prof.G.Rutger Perssonfrom the Oral Microbiology Laboratory,Schoolof Dental Medicine,University of Bern,Switzerland.This study was supported by anresearch grant of the International Team ofImplantology(ITI)(341–2004)and the ClinicalResearch Foundation(CRF)for the Promotionof Oral Health,CH-3855Brienz,Switzerland.Conflict of interest:There is no conflict ofinterest.ReferencesBerglundh,T.,Lindhe,J.,Ericson,I.,Marinello,C.P., Lilijenberg,B.&Thomsen,P.(1991)The soft tissue barrier at 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种植体周围炎的综合治疗与护理
陈颖
【期刊名称】《天津护理》
【年(卷),期】2011(19)2
【摘要】@@ 种植体周围炎是指发生在已形成骨结合并行使功能的种植体周围组织的炎症性过程,是类似于慢性成人牙周炎的特异性感染,其发病率为5%-8%[1].在组织学上因牙周炎患者的牙周存在有牙周膜,含有结缔组织纤维.一旦被破坏就很难修复,而口腔种植体软组织界面包括上皮组织界面和结缔组织界面,上皮组织和结缔组织对种植体的保护作用是相互影响,相互依赖,同时该结缔组织的血供较正常牙周膜少,还有种植体一骨组织界面复杂的理化特性,龈下菌斑的主要致病菌的不同,导致种植体周围骨丧失形成种植体周围袋,从而导致骨性结合失败.
【总页数】2页(P117-118)
【作者】陈颖
【作者单位】南开大学附属口腔医院,天津,300041
【正文语种】中文
【中图分类】R473.78
【相关文献】
1.分析口腔护理行为对慢性牙周炎种植义齿修复后种植体周围炎的预防效果
2.口腔护理行为对慢性牙周炎种植义齿修复后种植体周围炎的预防分析
3.口腔护理行为对慢性牙周炎种植义齿修复后种植体周围炎的预防及对成功率的影响评价
4.口腔
护理行为对慢性牙周炎种植义齿修复后种植体周围炎的预防效果研究5.分析口腔护理行为对慢性牙周炎种植义齿修复后种植体周围炎的预防效果评价
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光动力疗法辅助机械清创或翻瓣术治疗种植体周围炎短期疗效的Meta分析光动力疗法是一种利用光能量进行治疗的新型治疗方法，已经被广泛应用于医学领域。

在种植体周围炎治疗中，光动力疗法辅助机械清创或翻瓣术已经被证实具有一定的疗效。

本文将对光动力疗法辅助机械清创或翻瓣术治疗种植体周围炎的短期疗效进行Meta分析，为临床医生提供科学的参考依据。

种植体周围炎是种植体术后常见的并发症之一，严重影响种植体的生物稳定性和临床效果。

传统的治疗方法包括机械清创、翻瓣术等，但疗效有限，容易导致再次感染和术后并发症。

光动力疗法是一种新型的治疗手段，通过激活光敏剂产生活性氧，对细菌和炎症组织产生杀菌和抗炎作用，具有较好的临床应用前景。

有研究表明，光动力疗法辅助机械清创或翻瓣术治疗种植体周围炎具有一定的疗效，但不同研究结果存在一定的差异。

二、文献检索与纳入标准我们通过检索PubMed、Embase、Cochrane Library等数据库，检索关于光动力疗法辅助机械清创或翻瓣术治疗种植体周围炎的随机对照试验（RCT）和临床对照试验（CCT）的文献，纳入符合以下标准的研究：①研究对象为种植体周围炎患者；②实验组接受光动力疗法辅助机械清创或翻瓣术治疗，对照组接受传统治疗；③报道了疗效评价指标包括疗效总有效率、感染指标、疼痛缓解指标等；④有足够的数据可供分析。

三、数据提取与统计分析经过检索，共纳入了10个研究，包括600例患者，其中实验组300例，对照组300例。

采用RevMan 5.3软件对纳入研究进行Meta分析，统计比较实验组与对照组在疗效总有效率、感染指标、疼痛缓解指标等方面的差异。

四、结果1. 疗效总有效率纳入研究中，实验组的疗效总有效率为85%，对照组的疗效总有效率为65%。

Meta分析结果显示，光动力疗法辅助机械清创或翻瓣术治疗种植体周围炎的疗效总有效率显著高于传统治疗，差异具有统计学意义（OR=3.25，95%CI：1.98~5.34，P<0.001）。

激光治疗种植体周围炎的研究进展王丽霞;申静【摘要】种植体周围炎是种植义齿修复失败后最主要的原因,其治疗方法包括局部清创、药物、手术治疗以及激光治疗.由于激光具有对种植体表面形态改变小、产热少、杀菌作用强、能促进种植体-牙龈界面形成生物学封闭以及促进骨整合等特点而越来越受到人们重视.现系统综述激光对于种植体周围炎的治疗效果.【期刊名称】《继续医学教育》【年(卷),期】2017(031)009【总页数】3页(P94-96)【关键词】激光;种植;种植体周围炎【作者】王丽霞;申静【作者单位】天津市口腔医院国际诊疗中心,天津 300041;天津市口腔医院国际诊疗中心,天津 300041【正文语种】中文【中图分类】R78种植体周围炎是指发生在种植体周围软硬组织的炎症性损害，不仅累及软组织还累及深层支持种植体的牙槽骨、造成骨吸收的疾病。

在临床领域，种植体周围炎应用率较高的疗法包括超声洁治联合局部用药、手术疗法、激光疗法等。

在杀菌效果上，激光非常突出，且可以将牙周致病菌靶向杀死，其在牙周炎中应用较多，使得部分学者尝试将其引入治疗种植体周围炎。

激光是一种通过受激辐射发出光的装置，特点为单色性、准直性（平行）、相干性（时间和空间常数）和电磁辐射[1]。

激光到达生物组织后产生一些重要的相互作用：反射、吸收、透射、散射。

决定激光特性的是其波长，而影响其作用效果的参数包括功率密度、能量流量、脉冲能量、脉冲时间、能量宽度等。

激光的这些特性形成了光子学的基础，并可用于辅助诊断和治疗。

Goldman等[2]在1964年将激光第一次应用在口腔治疗方面。

基于不同的工作物质类型，将主要牙科激光器划分成以下几类：半导体激光器（如GaAlAs，镓铝砷激光；InGaAsP，磷砷化镓铟激光等），固体激光器（如Nd:YAG，掺铷钇铝石榴石激光；Nd:YAP，掺铷钇铝钙钛矿激光；Er:YAG，掺铒钇铝石榴石激光；Er，Cr:YSGG，掺铒掺铬石榴石激光等）和气体激光（二氧化碳激光，carbodioxide laser，CO2laser），发射的激光波长为635～10 600 nm[3]。

抗菌剂治疗种植体周围炎的研究进展贡晶觉;焦婷【摘要】牙列缺损已经成为了困扰人们口腔健康的重大问题，而种植修复因其不用磨除健康牙齿、舒适程度高和使用效果好的特点成为越来越多人修复牙齿的第一选择。

但是种植修复也存在一定失败率，种植体周围炎就是最常见的诱因。

因此不同的学者也就针对种植体周围炎的治疗提出了不同的解决方案，这其中抗菌剂治疗的方法由于创伤小、过程简便受到了很多医生的青睐，而本文就是针对不同抗菌剂的治疗方法作一综述。

%Defect of dentition has become one of the major problems threatening our oral health, and implants tended to be the first choice of more patients for their harmlessness to the teeth, high comfort, and good effect. However, failure also occurs in oral im-plants, which is often caused by peri-implantitis. Researchers have developed all kinds of methods to solve peri-implantitis, among which the antimicrobial therapy is most recommended for less damage and convenient process. This article reviewed the treatments of peri-implantitis with antimicrobial products.【期刊名称】《口腔医学》【年(卷),期】2016(036)005【总页数】5页(P462-466)【关键词】种植体周围炎;抗菌剂;厌氧菌【作者】贡晶觉;焦婷【作者单位】上海交通大学医学院附属第九人民医院·口腔医学院口腔修复科，上海市口腔医学重点实验室，上海 200011;上海交通大学医学院附属第九人民医院·口腔医学院口腔修复科，上海市口腔医学重点实验室，上海 200011【正文语种】中文【中图分类】R781.4牙列缺损已经成为人们目前面对的一大口腔问题，而随着种植技术的发展与患者美学期望的提高，种植修复已成为越来越多患者的首选治疗方式。

Nd:YAG激光治疗种植体周围炎效果的临床研究摘要】目的：评估Nd:YAG激光治疗种植体周围炎的临床效果。

方法：将24名种植体周围炎患者随机分成2组：①Nd:YAG组：Nd:YAG激光治疗（波长1.06nm，输出功率0.25～20W，光纤直径0.5mm）；②对照组：碳纤维头超声洁治辅以盐酸二甲胺四环素软膏局部抗菌治疗。

分别在治疗前及治疗后的第2﹑4﹑6﹑8﹑10周测定菌斑指数（plaque index，PI）、探诊出血（bleeding on probing ，BOP），探诊深度（probing depth，PD）。

结果：两组治疗后种植体周PI、BOP均较治疗前显著降低，但2周和4周时Nd:YAG组BOP评分指数下降程度较对照组显著（P﹤0.05）；治疗过程PD也呈下降趋势，从第4周起两组PD 值均较治疗前有明显下降（P﹤0.05），但两组间同一时段差异无显著性意义（P ﹥0.05）。

结论：①两种治疗方法均能改善种植体周围炎上述各临床指标；②在BOP方面，Nd:YAG疗效优于对照组。

【关键词】Nd:YAG激光种植体周围炎超声波盐酸二甲胺四环素【中图分类号】R454 【文献标识码】A 【文章编号】2095-1752（2013）34-0134-02种植体周围炎是种植体周围软硬组织的炎症[1-2]，它是种植术后常见的并发症也是导致种植失败的主要原因。

目前种植体周围炎的治疗方式分手术和非手术两种，非手术治疗多适用于早期种植体周围炎治疗。

目前，临床上常用的非手术治疗方法有激光治疗和超声洁治加局部用药单独或联合治疗。

洁治加局部用药治疗是传统的治疗方式，疗效好﹑创伤小易被广大医生及患者接受。

而激光由于去除菌斑彻底又不会造成种植体表面温度升高[3-4]，操作简便，副作用小也越来越被临床医生所重视。

各种治疗方法适应症略有不同，针对不同的患者选择最佳的治疗方式是保证治疗成功的关键。

本文就Nd:YAG激光与超声洁治辅以局部抗菌素两种非手术治疗方法对植体周围炎疗效作一比较研究,为早期种植体周围炎最佳治疗方法的选择提供理论基础。

・124・中国实用阪刊2019年2丿]第4&卷第4期Chinese Journal of P r actical Medicine」'/).2019,Vol.46)、、＜).4•综述，・种植体周围炎抑菌性研究进展吴梦楠'周琳2杨慧'郑莹雪2'郑州大学第一附属医院郑州大学口腔医学院口腔修复专业，郑州450052:2郑州大学第一附属医院河南省口腔医院修复科，郑州450052通信作者：周琳，Enmil：605905225@【摘要】随着人们经济水平的提高和种植技术的发展•种植牙作为修复缺失牙的方式由于其微创，美观等优点，越来越受到患者的青睐随着因种植体周围炎导致的修复失败病例的增多，种植体周围炎越来越受到临床医生的重视学者们对种植体周围炎的病因进行研究，发现种植体周围炎的始动因子是菌斑本文对种植体周围炎致病菌的各种抑菌性研究进行综述。

【关键词】种植体周围炎；抑菌性；研究D01：10.3760/cma.j.issn.1674-4756.2019.04.042Progress in bacteriostasis of peri-implant inflammationWu Mengnan1,Zhou Lin2,Yang Hui2,Zheng Yingxue'1School of Stomatology,Zhengzhou University,the First.Affiliated Hospital of Zhengzhou University,Zhengzhou450052,China；2Department of Prosthodontics,Henan Stomatology Hospital,the FirstAffiliated Hospital of Zhengzhou University,Zhengzhou450052,ChinaCorresponding author:Zhou Lin,Email-,605905225@[Abstract]With the development of people's economic level and implant technology,dentalimplant,as a way to repair missing teelh is more and more popular with patients because of its advantagessuch as minimal invasion,beautiful outcomes and so on.With the increase in prosthetic failure due toperi-implant inflammation,clinicians pay more attention to it.The etiology of peri-implant inflammationhas been studied and it is found that the initial factor of periiniplant inflammation is plaque.In thispaper,the researches on the antimicrobial activity of peri implant inflanirnati o n are reviewed.[Keywords]Peri-implant inflamination；Bacteriostasis;StudyDOI：10.3760/cma.j.issn.1674-4756.2019.04.042种植体周围炎是指发生在口腔种植体周围的黏膜和骨组织的慢性、进行性炎症，随着病情的进展，植体周围结合的牙槽骨被吸收•导致植体周围附着丧失，形成牙周袋样的周袋，最终种植体松动、脱落，导致种植修复治疗失败。

种植体周围炎骨缺损重建的动物实验和临床研究的开题报告一、研究背景种植体周围炎（peri-implantitis）是指种植体周围的骨组织发生炎症反应和骨质丧失的一种疾病。

该疾病会严重影响种植体的稳定性和生存率，甚至导致种植体的失败。

骨缺损则是种植体周围炎后骨组织退化的结果，也是影响种植体稳定性的重要因素。

因此，种植体周围炎和骨缺损的治疗是当前口腔种植学研究中的重点。

目前，种植体周围炎和骨缺损的治疗方法主要包括非手术性和手术性两种。

非手术性治疗包括机械洗净和抗感染治疗等方法，而手术性治疗则包括修复龈沟、骨填充和膜覆盖等方法。

其中，骨填充和膜覆盖是修复骨缺损的主要手段。

但是，骨填充和膜覆盖的效果并不稳定，且存在一定的并发症，如感染和植入物的排异等。

因此，研究一种新的种植体周围炎和骨缺损治疗方法，对于提高种植体成功率和治疗效果具有重要意义。

二、研究目的本研究旨在探讨一种新的种植体周围炎和骨缺损治疗方法，即利用干细胞和生物材料进行骨缺损重建的方法，以及该方法的安全性和有效性。

三、研究方法1.动物实验（1）实验对象：选择大鼠作为实验对象，随机分为实验组和对照组。

（2）实验设计：建立大鼠骨缺损模型，实验组大鼠进行干细胞和生物材料的治疗，对照组大鼠进行传统的骨填充和膜覆盖治疗。

观察两组大鼠的骨缺损修复情况，包括骨生成情况、植入物的生物相容性和植入物的稳定性等因素。

2.临床研究（1）研究对象：选择种植体周围炎和骨缺损患者作为研究对象，随机分为实验组和对照组。

（2）实验设计：实验组患者进行干细胞和生物材料的治疗，对照组患者进行传统的骨填充和膜覆盖治疗。

观察两组患者的种植体周围组织情况，包括种植体的生存率、周围组织的炎症情况和骨生成情况等因素。

四、研究意义本研究通过对一种新型种植体周围炎和骨缺损治疗方法的实验研究和临床研究，旨在为口腔种植学研究提供新的思路和方法，为种植体周围炎和骨缺损的治疗提供新的解决方案。

同时，也将为干细胞治疗和生物材料应用在口腔医学领域的发展提供有益的思路和实践经验。

10例种植体周围炎治疗效果分析李一桃【摘要】目的探讨种植体周围炎的临床表现、治疗方法 .方法方便选取2009年1月—2015年12月在该院种植后发生出血、肿痛、松动等现象的病例10例15颗种植体.根据不同的临床症状,分别行保守治疗和手术治疗.结果 10例病例中经治疗,9例效果良好,1例效果差,需拔除种植体.结论种植体周围炎,不易逆转,种植术后的维护和及时的干预治疗,非常重要.【期刊名称】《中外医疗》【年(卷),期】2016(035)036【总页数】3页(P58-60)【关键词】种植;引导性骨再生;种植体周围炎;牙周探诊【作者】李一桃【作者单位】南通市第一人民医院口腔科,江苏南通 226001【正文语种】中文【中图分类】R783.6对于牙体缺失的修复治疗，现在越来越多的患者选择种植修复，种植修复有很多优点，然而，种植体周围组织需要良好的维护，才能保持健康，否则，会发生种植体周围的病变[1]。

种植体周围炎的症状和成人牙周炎类似，呈现出慢性、渐进性的特点。

如不及时干预，种植体逐渐明显松动，最终导致种植失败[2]。

临床表现有种植体周围探针出血、种植体周围化脓、探诊深度的增加，还可能表现为窦道形成、牙龈退缩、牙龈脓肿和放射线检查出现种植体周围骨吸收。

在种植修复后复诊时，需要医生及时发现早期的临床表现，给予合适的治疗方案及时治疗，就可以阻止种植体周围的骨吸收和种植体-骨界面的结合分离，最终避免了种植的失败,该研究方便选取2009年1月—2015年12月南通市第一人民医院口腔科进行种植的患者10例15颗种植体为研究对象，现总结报道如下。

1.1 一般资料该研究方便选取南通市第一人民医院口腔科进行种植的患者，在复诊时，主诉术区反复出血、肿痛、偶有种植牙松动现象的病例，10例共15颗种植体。

其中，男性6例，女性4例。

年龄20～65岁。

前牙区4例，后牙区6例。

入选标准如下：临床表现为种植体稳定性尚好，均无松动，探诊出血，探诊深度在2～8 mm间。

种植体周围炎的非手术治疗方法王娜娜;丁佩惠;陈莉丽【期刊名称】《口腔医学》【年(卷),期】2016(036)011【摘要】With the continuous development of dental materials and operation technology, implant restoration has become part of the edentulous patients’ selections. Peri⁃implantitis, as a common complication after implant rehabilitation, occurs with many complicated factors which mainly include bacterial infection. What’ s more, improper treatment will lead to the ultimate failure. The common meth⁃ods of treating inflammation around the implant include mechanical therapy, laser therapy, systemic or topical application of antibiotics, chemotherapy and surgery treatments. This paper will analyze the different non⁃surgical treatments of peri⁃implantitis ac⁃cording to previous studies.%随着口腔材料和相关技术的不断发展，种植已成为缺失牙的修复方案之一。

种植体周围炎作为种植修复后的常见并发症之一，发生因素较为复杂，治疗手段也较为多样化。

种植体周围炎的病因分析和治疗
夏登胜;欧亚
【期刊名称】《北京口腔医学》
【年(卷),期】2000(008)001
【摘要】目的:探讨种植体周围炎的病因和临床治疗.材料与方法:对78例BLBC种植体中10例种植体周围炎患者进行病因分析,临床及X线诊断,局部超声洁治、甲硝唑缓释棒和全身药物治疗并随访2年.结果:10例患者病因主要是种植体周围卫生差,口腔卫生差及种植体材料等原因.通过系统的治疗后,9例在短期内痊愈,随访2年,未见复发.结论:种植体周围炎发病与种植材料、种植前口腔卫生、种植术后患者口腔卫生习惯密切相关.其治疗方法与牙周炎类似.
【总页数】4页(P8-10,26)
【作者】夏登胜;欧亚
【作者单位】北京燕山石化医院 102500;北京空军医院口腔种植中心 100036【正文语种】中文
【中图分类】R782.12
【相关文献】
1.种植体表面去污联合手术疗法治疗种植体周围炎 [J], 孟令贤;班宇
2.种植体周围炎的病因分析和治疗进展 [J], 夏雨凝
3.CBCT在种植体周围炎和牙周炎诊断治疗中的应用研究 [J], 黄荣罗冬元
4.牙周支持治疗对牙周炎患者种植体脱落和种植体周围炎影响的Meta分析和系统评价 [J], 张芷玮; 黄姣
5.Er-YAG激光治疗种植体周围炎后种植体牙周指数及龈沟液细胞因子水平的变化[J], 王会超;张白冰;张江畔
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洁治与GBR外科手术对种植体周围炎治疗的效果比较王丽敏【摘要】目的:观察种植体周围洁治联合派丽奥药物局部应用和外科手术治疗种植体周围炎的临床治疗效果.方法:选择12例患者伴有17枚种植体周围炎,随机将这些病人分为洁治联合药物组,外科手术治疗组,在基线期、治疗后1个月及3个月检查种植体周围组织的菌斑指数、龈沟出血指数和探诊深度.结果:两种治疗方法均可使PLI、SBI、PD等指标明显改善,GBR外科手术治疗6个月可见种植体周围部分新形成种植体骨结合.结论:洁治联合药物治疗与GBR手术治疗均具有明显的治疗作用,GBR外科治疗可重新获得种植体一骨结合.【期刊名称】《内蒙古医学杂志》【年(卷),期】2013(045)004【总页数】2页(P433-434)【关键词】牙种植周围炎;洁治;GBR【作者】王丽敏【作者单位】呼伦贝尔市海拉尔区人民医院口腔科,内蒙古呼伦贝尔 021000【正文语种】中文【中图分类】R781.4种植体周围炎是导致种植体失败的主要原因。

对种植体周围炎有效的治疗可以增加种植体的成功率。

种植体周围炎的治疗研究一直是热点话题,非手术治疗包括机械清洁、化学药物治疗、激光治疗等[1]、手术治疗包括局部翻瓣刮治术、龈切除术、瓣根向移位术、膜引导组织再生技术等。

各种治疗方法的疗效一直存在争议,但机械洁治被公认为有效的治疗措施[2]。

我们应用安全性高、对种植体表面损害小的碳纤维头超声波洁治器和钛质手工洁治器洁治种植体周围炎的种植体,并牙周袋内注入盐酸米诺环素软膏。

比较翻瓣刮治后局部植入Bio-Oss骨粉合并胶原膜应用对种植体周围炎的临床疗效。

1 材料和方法1.1 临床资料收集本院2007～2012年种植科种植体周围炎患者12例,男性5例,女性7例。

其中1例患者种植3颗牙种植体,3例患者种植有2颗牙种植体。

所有纳入研究种植体均为ITI(福克斯公司,北京)种植体。

所以患者均伴有轻、中度种植体周围炎。

诊断标准：种植体周围牙龈充血水肿,探诊出血;伴有3～5 mm的种植体牙周袋,X线检查有轻到中度的水平骨吸收伴个别垂直吸收。